Das Meckel-Divertikel: Sicherheit der Resektion symptomatischer und asymptomatischer Befunde und Literaturübersicht

 

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Zusammenfassung

Hintergrund: Als häufigste angeborene Fehlbildung des Gastrointestinaltrakts ist das Meckel-Divertikel (MD) ein wichtiges Krankheitsbild in der Praxis des Viszeralchirurgen. Ziel dieser Arbeit war es, die Sicherheit der Resektion von MD in Bezug auf postoperative Komplikationen zu analysieren. Aufgrund der relativen Seltenheit des MD wird zudem ein Überblick über die Literatur gegeben.

Patienten und Methoden: Alle Patienten, bei denen zwischen 1996 und 2010 an der Chirurgischen Klinik I der Charité – Campus Benjamin Franklin ein MD beschrieben wurde, wurden erfasst. Es erfolgte ein Vergleich zwischen symptomatischen und inzidentellen MD in Hinsicht auf Inzidenz, Operationsindikation, intraoperativen Befund, Histologie und früh-postoperatives Outcome.

Ergebnisse: Bei 71 von 29 682 Patienten (0,2 %) wurde intraoperativ ein MD festgestellt. Symptomatische MD zeigten sich bei 26 Patienten (37 %). Bei 6 der 7 Patienten mit gastrointestinaler Blutung (GIB) fand sich ursächlich ein symptomatisches MD (p = 0,005). Alle symptomatischen und 30 (67 %) der asymptomatischen MD wurden reseziert. Ektope Magenschleimhaut lag bei Patienten mit symptomatischem MD signifikant häufiger vor (p = 0,001). Patienten mit asymptomatischem MD und Resektion hatten tendenziell seltener postoperative Komplikationen als Patienten mit symptomatischen MD (p = 0,057).

Schlussfolgerung: Ektopes Gewebe kommt bei symptomatischen MD signifikant häufiger vor, insbesondere bei blutenden MD. Bei einer GIB unklarer Ursache sollte ein MD in Betracht gezogen werden. Die Resektion inzidentell aufgefundener MD kann empfohlen werden, solange keine Kontraindikationen wie Peritonitis, Lebenszeit beschränkende Tumorerkrankung, Aszites oder Immunsuppression bestehen.

Abstract

Background: Meckelʼs diverticulum (MD) is the most common diverticulum of the small bowel and an important finding in surgical practice. The aim of this study was to assess the safety of the resection of symptomatic and asymptomatic MD concerning postoperative complications. As MD are relatively rare, an overview of the literature is given.

Patients and Methods: All patients with MD at the department at general surgery of the Charité – Campus Benjamin Franklin between 1996 and 2010 were assessed. An analysis for symptomatic and incidental MD was performed for incidence, indication, intraoperative findings, histology and postoperative outcome.

Results: An MD was intraoperatively found in 71 of 29 682 patients (0.2 %). Of these, a symptomatic MD occurred in 26 patients (37 %). A symptomatic MD was causal in 6 of 7 patients with gastrointestinal bleeding (GIB, p = 0.005). All symptomatic MD and 30 (67 %) asymptomatic MD were resected. Ectopic gastric mucosa was found significantly more frequently in patients with symptomatic MD (p = 0.001). Patients with asymptomatic MD and resection had less complications as a trend (p = 0.057).

Conclusion: Ectopic mucosa is more frequent in symptomatic MD, especially in bleeding MD. MD should always be considered in GIB of unknown origin. Resection of incidental MD can be recommended in patients without contraindications such as peritonitis, cancer, ascites or immunosuppression.

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